ABSTRACT
Small airways disease (SAD) is defined as a pathologic condition in which the small
conducting airways are affected either primarily or as part of other pulmonary changes.
Diagnosis is often difficult because the many histopathologic subtypes that have been
described often lack obvious clinical or imaging correlates and because widespread
involvement is needed before clinical symptoms and abnormalities on pulmonary function
testing occur. High-resolution computed tomography (HRCT) can be helpful to detect,
characterize, and quantify small airways involvement. These airways may become visible
directly when inflammation of the bronchiolar wall and accompanying exudates develop.
Obstruction of the small airways may be detected indirectly by HRCT when it causes
regional underventilation resulting in reduced perfusion. This article discusses the
direct and indirect HRCT signs of small airways involvement and, based on the fundamental
differences between these signs, gives a short review of the HRCT features of the
most important diseases that can affect the small airways.
KEYWORDS
Computed tomography - small airways disease - bronchiolitis